Inpatient Prospective Payment System (IPPS) FY 2020 Proposed Rule Highlights

The IPPS FY 20 was released on April 24, 2019. Below are the highlights of the proposed changes.

CC/MCC Summary – Over 1000 codes that are currently CCs will become non-CCs in the proposed rule

Proposed Shifts #
Non-CC to CC 183
CC to non-CC 1,148
CC to MCC 8
MCC to non-CC 17
MCC to CC 136
Total 1,492

Proposed CC/MCC changes (not complete listing)

ICD-10-CM Description Proposed
D61.810 Antineoplastic chemotherapy
induced pancytopenia
D62 Acute posthemorrhagic anemia CC to non-CC
D70.9 Neutropenia, unspecified Non-CC to CC
E43 Unspecified severe
protein-calorie malnutrition
G93.5 Compression of brain MCC to CC
I21.01-I21.11 ST elevation MI MCC to CC
K70.11 Alcoholic hepatitis with ascites Will remain non-CC
K70.31 Alcoholic cirrhosis with ascites Will remain non-CC
K71.51 Toxic liver disease with chronic
active hepatitis with ascites
Will remain non-CC
L89.- Pressure ulcers (unstageable,
unspecified, stage 1-2)
Non-CC to CC
L89.- Pressure ulcers (stage 3-4) MCC to CC
N18.4-N18.5 Chronic kidney disease, stage
CC to non-CC
N18.6 ESRD MCC to CC
R04.0 Epistaxis Non-CC to CC
R60.1 Generalized edema Non-CC to CC
R62.7 Adult failure to thrive Non-CC to CC
R78.81 Bacteremia CC to MCC
Z68.1 Body mass index (BMI) 19.9 or
less, adult
CC to non-CC
Z68.41-Z68.42 Body mass index (BMI) 40.0-49.9 CC to non-CC
Z94.0-Z94.83 Kidney, lung, heart, liver, bone
marrow, intestine transplant status
CC to non-CC

MS-DRG Summary

  • 15 proposed MS-DRG revisions   
  • 2 MS-DRGs removed
  • 2 MS-DRGS added

Extensive OR Procedures Unrelated to PDX with MCC (DRGs 981-983)

  • The conditions and procedures listed below currently group to DRGs 981-983; the proposed changes will shift these condition and procedure combinations out of DRGs 981-983
    • Pressure ulcers with bone excision
    • Lower extremity muscle and tendon excision
    • Conditions in MDC 1 with insertion of feeding device
    • Conditions in MDC 21 with peritoneal dialysis catheter insertion, removal, or revision
    • Gastrointestinal Stromal Tumors (GIST) with excision of stomach and small intestine

OR procedures that will become non-OR procedures

  • Percutaneous removal of drainage device
  • Percutaneous drainage of pelvic cavity
  • Bronchial alveolar lavage (BAL)

Peripheral ECMO

  • 5A1522G – ECMO, peripheral veno-arterial and 5A1522H – ECMO, peripheral veno-venous will be reassigned to MS-DRG 003
  • The following DRGs will no longer include, “or Peripheral ECMO” in their DRG description:
    • DRG 207 – Resp. system DX with vent support > 96 hours or peripheral ECMO
    • DRG 291 – CHF with MCC or Peripheral ECMO
    • DRG 296 – Cardiac Arrest with MCC or Peripheral ECMO
    • DRG 870 – Sepsis with mechanical vent >96 or peripheral ECMO

Extracorporeal shockwave lithotripsy (ESWL)

  • Remove
    • 691 Urinary Stones with ESW Lithotripsy with CC/MCC
    • 692 Urinary Stones with ESW Lithotripsy without CC/MCC
  • Add
    • 693 Urinary Stones with MCC
    • 694 Urinary Stones without MCC 



Recent Insights

Newsletter Sign-Up